title: Correlates of muscle strength in diabetes: The study on the assessment of determinants of muscle and bone strength abnormalities in diabetes (SAMBA).
abstract: OBJECTIVE
  Apart from late motor nerve dysfunction, factors affecting muscle strength in diabetes are largely unknown. This study was aimed at assessing muscle strength correlates in diabetic subjects encompassing a wide range of peripheral nerve function and various degrees of micro and macrovascular complications.
  
  
  RESULTS
  Four-hundred consecutive patients with type 1 and 2 diabetes (aged 46.4 ± 13.9 and 65.8 ± 10.3 years, respectively) from the Study on the Assessment of Determinants of Muscle and Bone Strength Abnormalities in Diabetes (SAMBA) were examined for upper and lower body muscle isometric maximal voluntary contraction by dynamometry. Univariate and multivariate regression analyses were applied to identify strength correlates. Isometric force at both the upper and lower limbs was significantly lower in subjects with than in those without any complication. At univariate analysis, it was strongly associated with age, diabetes duration, physical activity (PA) level, cardio-respiratory fitness, anthropometric parameters, surrogate measures of complications, and parameters of sensory and autonomic, but not motor (except amplitude) neuropathy. Multivariate analysis revealed that upper and lower body strength correlated independently with male gender and, inversely, with age, autonomic neuropathy score (or individual autonomic function abnormalities), and vibration perception threshold, but not sensory-motor neuropathy score. Diabetes duration and PA level were excluded from the model.
  
  
  CONCLUSIONS
  Both upper and lower body muscle strength correlate with measures of diabetic complications and particularly with parameters of sensory and especially autonomic nerve function, independently of diabetes duration and PA level, thus suggesting the involvement of mechanisms other than manifest motor nerve impairment.
authors.affiliation: Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy. Electronic address: sbalducci@esinet.it.
authors.forename: S
authors.initials: S
authors.lastname: Balducci
authors.affiliation: Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sacchetti
authors.affiliation: Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Salvi
authors.affiliation: Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pugliese
authors.affiliation: Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Salerno
authors.affiliation: Diabetes Unit, Sant'Andrea Hospital, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: D'Errico
authors.affiliation: Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Metabolic Fitness Association, Monterotondo, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Iacobini
authors.affiliation: Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
authors.forename: F G
authors.initials: FG
authors.lastname: Conti
authors.affiliation: School of Science, University of Greenwich, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Zanuso
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nicolucci
authors.affiliation: Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy; Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016472:Motor Neuron Disease / Q000175:diagnosis* / Q000503:physiopathology; D015999:Multivariate Analysis; D053580:Muscle Strength / Q000502:physiology*; D011446:Prospective Studies
keywords: Chronic kidney disease; Diabetes; Muscle strength; Peripheral neuropathy